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General NPI Number Information
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NPI Number | 1003631730
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Entity Type | Organization
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Legal Business Name | GOODPLACE MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 03/21/2026
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Provider Practice Location Address
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Address Line | 600 TWELVE OAKS CENTER DR STE 217
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City | WAYZATA
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State | MN
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Zip | 55391-4541
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Country | US
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Telephone | 952-217-0240
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Fax | 612-230-8820
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Provider Business Mailing Address
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Address Line | 10343 41ST PL NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-3045
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Country | US
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Telephone | 952-217-0240
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MICHAEL TOCHUKWU NWANNA
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Credential |
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Telephone | 952-217-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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